2018 Endovascular Reimbursement Coding Fact Sheet

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The information contained in this document is provided for informational purposes only and represents no statement, promise, or guarantee by Cordis Corporation concerning levels of reimbursement, payment, or charge. Similarly, all CPT, ICD-10 and HCPCS codes are supplied for informational purposes only and represent no statement, promise, or guarantee by Cordis that these codes will be appropriate to specific circumstances or products or services provided or that reimbursement will be made. Providers are ultimately responsible for exercising their independent clinical judgment to determine medical necessity for individual patients and the appropriate billing process according to the applicable payer’s current policy. CPT codes and descriptions are copyright 2018 American Medical Association. ICD-10 codes and descriptions are copyright 2018 World Health Organization; revised for use in the United States by the Centers for Medicare and Medicaid Services (CMS) and the Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics (NCHS) as ICD-10-CM / ICD-10-PCS. Healthcare Common Procedure Coding System (HCPCS) Level II codes and descriptions are maintained by the CMS HCPCS Workgroup. The information contained in this document is taken from various publicly available documents, is current at the date of publication and is subject to change at any time. CPT® Codes and Physician Reimbursement

Medicare Part B pays for physician services based upon the Medicare Physician Fee Schedule (MPFS). Fee schedule amounts are calculated according to the Resource-Based Relative Value Scale (RBRVS), which is updated each year. Procedures are reported using CPT® codes.1 The 2018 CPT Professional Edition Manual also provides specific instructions for reporting particular families of codes. Individual payers may also have guidelines and coverage policies regarding certain services. The following table lists the most commonly used codes for biliary diagnostic and therapeutic procedures.

Procedure Codes and Physician Reimbursement for Endovascular Procedures 2018 Medicare Base CPT® 2018 Work 2 Description Payment Rate Code RVUs Non-Facility Facility Nonselective and Selective Catheter Placement - Arterial 36100 Introduction of needle or intracatheter, carotid or vertebral artery 3.02 $496 $162 36120 Introduction of needle or intracatheter; retrograde brachial artery 2.01 $427 $106 36140 Extremity artery 1.76 $437 $95 36200 Introduction of catheter, aorta 2.77 $572 $146 Selective catheter placement, arterial system; each first order thoracic or 36215 4.17 $1,031 $222 brachiocephalic branch, within a vascular family Initial second order thoracic or brachiocephalic branch, within a 36216 5.27 $1,118 $286 vascular family Initial third order or more selective thoracic or brachiocephalic branch, 36217 6.29 $1,899 $342 within a vascular family Additional second order, third order, and beyond, thoracic or +36218 1.01 $258 $54 brachiocephalic, within a vascular family Selective catheter placement, arterial system; each first order abdominal, 36245 4.65 $1,337 $250 pelvic, or lower extremity artery branch, within a vascular family Initial second order abdominal, pelvic, or lower extremity artery 36246 5.02 $840 $267 branch, within a vascular family Initial third order or more selective abdominal, pelvic, or lower 36247 6.04 $1,530 $317 extremity artery branch, within a vascular family

1 2018 Current Procedural Terminology (CPT®), ©2018 American Medical Association. CPT® is a registered trademark of the American Medical Association. 2 The MPFS payment amounts are based upon data elements published by the Centers for Medicare and Medicaid Services (CMS-1677-F) in the Final Rule [CMS-1654-F] on August 14, 2017, and published in the Federal Register on December 14, 2017, with a conversion factor of $35.99. CMS may make adjustments to any or all of the data inputs from time to time. 1 of 11 2018 Endovascular Reimbursement Coding Fact Sheet

Procedure Codes and Physician Reimbursement for Endovascular Procedures 2018 Medicare Base CPT® 2018 Work 2 Description Payment Rate Code RVUs Non-Facility Facility Additional second order, third order, and beyond, abdominal, pelvic, or +36248 1.01 $156 $51 lower extremity artery branch, within a vascular family Diagnostic Imaging - Arterial 75600 Aortography, thoracic, without serialography, radiological S&I 0.49 $204 $25 75605 Aortography, thoracic, by serialography, radiological S&I 1.14 $140 $57 75625 Aortography, abdominal, by serialography, radiological S&I 1.14 $139 $57 Aortography, abdominal plus bilateral iliofemoral lower extremity, catheter, 75630 1.79 $174 $90 by serialography, radiological S&I Computed tomographic angiography, abdominal aorta and bilateral 75635 2.40 $449 $121 iliofemoral lower extremity runoff, with contrast material(s) 75658 Angiography, brachial, retrograde, radiological S&I 1.31 $171 $66 75705 Angiography, spinal, selective, radiological S&I 2.18 $258 $118 75710 Angiography, extremity, unilateral, radiological S&I 1.75 $175 $88 75716 Angiography, extremity, bilateral, radiological S&I 1.97 $199 $99 Angiography, visceral, selective or supraselective (with or without flush 75726 1.14 $152 $57 aortogram), radiological S&I 75731 Angiography, adrenal, unilateral, selective, radiological S&I 1.14 $175 $59 75733 Angiography, adrenal, bilateral, selective, radiological S&I 1.31 $188 $65 75736 Angiography, pelvic, selective or supraselective, radiological S&I 1.14 $163 $56 75741 Angiography, pulmonary, unilateral, selective, radiological S&I 1.31 $153 $64 75743 Angiography, pulmonary, bilateral, selective, radiological S&I 1.66 $172 $82 Angiography, pulmonary, by nonselective catheter or venous injection, 75746 1.14 $154 $57 radiological S&I 75756 Angiography, internal mammary, radiological S&I 1.14 $176 $58 Angiography, selective, each additional vessel studied after basic +75774 0.36 $88 $18 examination, radiological S&I Nonselective and Selective Catheter Placement - Venous 36005 Injection procedure for extremity venography 0.95 $332 $50 36010 Introduction of catheter, superior or inferior vena cava 2.18 $492 $114 36011 Selective catheter placement, venous system; first order branch 3.14 $847 $164 36012 Second order, or more selective, branch 3.51 $868 $181 Diagnostic Imaging - Venous 75820 Venography, extremity, unilateral, radiological S&I 0.70 $118 $36 75822 Venography, extremity, bilateral, radiological S&I 1.06 $138 $53 75825 Venography, caval, inferior, with serialography, radiological S&I 1.14 $137 $57 75827 Venography, caval, superior, with serialography, radiological S&I 1.14 $141 $58

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Procedure Codes and Physician Reimbursement for Endovascular Procedures 2018 Medicare Base CPT® 2018 Work 2 Description Payment Rate Code RVUs Non-Facility Facility 75831 Venography, renal, unilateral, selective, radiological S&I 1.14 $143 $57 75833 Venography, renal, bilateral, selective, radiological S&I 1.49 $169 $75 75840 Venography, adrenal, unilateral, selective, radiological S&I 1.14 $151 $59 75842 Venography, adrenal, bilateral, selective, radiological S&I 1.49 $181 $77 Venography, venous sinus (eg, petrosal and inferior sagittal) or jugular, 75860 1.14 $147 $57 catheter, radiological S&I 75870 Venography, superior sagittal sinus, radiological S&I 1.14 $151 $59 75872 Venography, epidural, radiological S&I 1.14 $151 $59 75880 Venography, orbital, radiological S&I 0.70 $128 $36 Renal Artery Angiography Selective catheter placement and radiological S&I, main renal artery and 36251 5.10 $1,412 $273 any accessory renal artery(s) and renal angiography S&I; unilateral 36252 Bilateral 6.74 $1,527 $378 Superselective catheter placement (one or more second order or higher 36253 renal artery branches) renal artery and any accessory renal artery(s) and 7.30 $2,255 $375 renal angiography S&I; unilateral 36254 Bilateral 7.90 $2,205 $442 Cerebrovascular Angiography Non-selective catheter placement, thoracic aorta, with angiography of 36221 the extracranial carotid, vertebral, and/or intracranial vessels, unilateral or 3.92 $1,048 $210 bilateral, and all associated radiological S&I, includes arch, when performed Selective catheter placement, common carotid or innominate artery, 36222 unilateral, any approach, with angiography of the ipsilateral extracranial 5.28 $1,234 $296 carotid circulation and all associated radiological S&I, includes arch Selective catheter placement, common carotid or innominate artery, unilateral, any approach, with angiography of the ipsilateral intracranial 36223 5.75 $1,546 $329 carotid circulation and all associated radiological S&I, includes angiography of the extracranial carotid and cervicocerebral arch, when performed Selective catheter placement, internal carotid artery, unilateral, with 36224 angiography of the ipsilateral intracranial carotid circulation, includes 6.25 $1,964 $373 angiography of the extracranial carotid and cervicocerebral arch Selective catheter placement, subclavian or innominate artery, unilateral, 36225 with angiography of the ipsilateral vertebral circulation and all associated 5.75 $1,488 $328 radiological S&I, includes angiography of the arch, when performed Selective catheter placement, vertebral artery, unilateral, with angiography 36226 of the ipsilateral vertebral circulation and all associated radiological S&I, 6.25 $1,904 $370 includes angiography of the arch, when performed Selective catheter placement, external carotid artery, unilateral, with +36227 angiography of the ipsilateral external carotid circulation and radiological 2.09 $263 $122 S&I

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Procedure Codes and Physician Reimbursement for Endovascular Procedures 2018 Medicare Base CPT® 2018 Work 2 Description Payment Rate Code RVUs Non-Facility Facility Selective catheter placement, each intracranial branch of the internal +36228 carotid or vertebral arteries, unilateral, with angiography of the selected 4.25 $1,352 $252 vessel circulation Lower Extremity Interventions 37220 Angioplasty, iliac artery, unilateral, initial vessel 7.90 $3,121 $422 37221 Stent placement(s), iliac artery, unilateral, initial vessel; 9.75 $4,631 $521 +37222 Angioplasty, iliac artery, each additional ipsilateral iliac vessel 3.73 $877 $196 +37223 Stent placement(s), iliac artery, each additional ipsilateral iliac vessel 4.25 $2,595 $224 37224 Angioplasty, femoral, popliteal artery(s), unilateral 8.75 $3,790 $467 37225 Atherectomy, femoral, popliteal artery(s), unilateral 11.75 $11,130 $637 37226 Stent placement(s), femoral, popliteal artery(s), unilateral 10.24 $9,100 $549 37227 Stent placement(s) and atherectomy, femoral, popliteal artery(s), unilateral 14.25 $15,061 $765 37228 Angioplasty, tibial, peroneal artery, unilateral, initial vessel 10.75 $5,424 $572 37229 Atherectomy, tibial, peroneal artery, unilateral, initial vessel 13.80 $10,976 $742 37230 Stent placement(s), tibial, peroneal artery, unilateral, initial vessel 13.55 $8,389 $735 37231 Stent and atherectomy, tibial/peroneal artery, unilateral, initial vessel 14.75 $13,605 $799 +37232 Angioplasty, tibial, peroneal artery, unilateral, each additional vessel 4.00 $1,210 $212 +37233 Atherectomy, tibial/peroneal artery, unilateral, each additional vessel 6.50 $1,465 $346 +37234 Stent placement(s), tibial/peroneal artery, unilateral, each additional vessel 5.50 $3,969 $300 +37235 Stent and atherectomy, tibial/peroneal artery, unilateral, each additional 7.80 $4,194 $420 vessel Carotid Artery Stent Placement Transcatheter placement of intravascular stent(s), cervical carotid artery, 37215 open or percutaneous, including angioplasty, when performed, and 17.75 $0 $1,050 radiological S&I; with distal embolic protection 37216 Without distal embolic protection 0.00 $0 $0 Transcatheter placement of intravascular stent(s), intrathoracic common carotid artery or innominate artery by retrograde treatment, open 37217 20.38 $0 $1,135 ipsilateral cervical carotid artery exposure, including angioplasty, and radiological S&I Transcatheter placement of intravascular stent(s), intrathoracic common 37218 carotid artery or innominate artery, open or percutaneous antegrade 14.75 $0 $851 approach, including angioplasty, and radiological S&I Angioplasty / Atherectomy / Stenting in Other Vessels Transcatheter placement of an intravascular stent(s), open or 37236 8.75 $3,923 $467 percutaneous, including radiological S&I and angioplasty; initial artery +37237 Each additional artery 4.25 $2,469 $224

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Procedure Codes and Physician Reimbursement for Endovascular Procedures 2018 Medicare Base CPT® 2018 Work 2 Description Payment Rate Code RVUs Non-Facility Facility Transcatheter placement of an intravascular stent(s), open or 37238 6.04 $4,250 $314 percutaneous, including radiological S&I and angioplasty; initial vein 37239 Each additional vein 2.97 $2,058 $159 Transluminal balloon angioplasty, open or percutaneous, including 37246 7.00 $2,182 $365 radiological S&I; initial artery +37247 Each additional artery 3.50 $882 $179 Transluminal balloon angioplasty, open or percutaneous, including 37248 6.00 $1,514 $312 radiological S&I; initial vein +37249 Each additional vein 2.97 $648 $152 Transluminal atherectomy, open or percutaneous, including radiological 0234T 0.00 $0 $0 S&I; renal artery 0235T Visceral artery (except renal), each vessel 0.00 $0 $0 0236T Abdominal aorta 0.00 $0 $0 0237T Brachiocephalic trunk and branches, each vessel 0.00 $0 $0 0238T Iliac artery, each vessel 0.00 $0 $0 Vena Cava Filters 37191 Insertion of intravascular vena cava filter, endovascular approach 4.46 $2,618 $235 37192 Repositioning of intravascular vena cava filter, endovascular approach 7.10 $1,318 $368 37193 Retrieval (removal) of intravascular vena cava filter, endovascular approach 7.10 $1,562 $367 Dialysis Circuit Imaging and Intervention Introduction of needle(s) and/or catheter(s), dialysis circuit, with diagnostic 36901 3.36 $611 $176 angiography of the dialysis circuit, including inferior or superior vena cava; 36902 With transluminal balloon angioplasty, peripheral dialysis segment 4.83 $1,272 $251 With transcatheter placement of intravascular stent(s), peripheral 36903 6.39 $5,725 $333 dialysis segment Percutaneous transluminal mechanical thrombectomy and/or infusion for thrombolysis, dialysis circuit, any method, including all imaging and 36904 radiological supervision and interpretation, diagnostic angiography, 7.50 $1,849 $388 fluoroscopic guidance, catheter placement(s), and intraprocedural thrombolytic injection(s); 36905 With balloon angioplasty, peripheral dialysis segment 9.00 $2,344 $466 36906 With placement of intravascular stent(s), includes angioplasty 10.42 $6,949 $538 +36907 Transluminal balloon angioplasty, central dialysis segment 3.00 $770 $154 +36908 Transcatheter placement of intravascular stent(s), central dialysis segment 4.25 $2,763 $220 +36909 Dialysis circuit permanent vascular embolization or occlusion 4.12 $2,008 $217 Thrombolysis 37211 Transcatheter arterial infusion for thrombolysis, initial treatment day 7.75 $0 $404 37212 Transcatheter venous infusion for thrombolysis, initial treatment day 6.81 $0 $354

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Procedure Codes and Physician Reimbursement for Endovascular Procedures 2018 Medicare Base CPT® 2018 Work 2 Description Payment Rate Code RVUs Non-Facility Facility Transcatheter arterial or venous infusion for thrombolysis, continued 37213 treatment on subsequent day; including follow-up catheter contrast 4.75 $0 $244 injection, position change, or exchange, when performed; Cessation of thrombolysis including removal of catheter and vessel 37214 2.49 $0 $128 closure by any method Mechanical Thrombectomy Primary percutaneous transluminal mechanical thrombectomy; initial 37184 8.41 $2,261 $471 vessel +37185 Second and all subsequent vessel(s) in the same vascular family 3.28 $719 $176 Secondary percutaneous transluminal thrombectomy in conjunction with +37186 4.92 $1,361 $257 another percutaneous intervention 37187 Percutaneous transluminal mechanical thrombectomy, vein(s) 7.78 $2,025 $411 Percutaneous transluminal mechanical thrombectomy, vein(s), repeat 37188 5.46 $1,708 $293 treatment on subsequent day during course of thrombolytic therapy Embolization / Occlusion Vascular embolization or occlusion, inclusive of all radiological S&I; venous, 37241 8.75 $4,830 $465 other than hemorrhage 37242 Arterial, other than hemorrhage or tumor 9.80 $7,474 $502 37243 For tumors, organ ischemia, or infarction 11.74 $9,900 $590 37244 For arterial or venous hemorrhage or lymphatic extravasation 13.75 $6,901 $697 75894 Transcatheter therapy, embolization, any method, radiological S&I 1.31 $0 $74 Other Supportive Procedures +37252 Intravascular ultrasound; initial noncoronary vessel 1.80 $1,398 $96 +37253 Each additional noncoronary vessel 1.44 $211 $77 Angiography through existing catheter for follow-up study for 75898 transcatheter therapy, embolization or infusion, other than for 1.65 $0 $92 thrombolysis 37197 Transcatheter retrieval, percutaneous, of intravascular foreign body 6.04 $1,481 $316

Ambulatory Surgery Center (ASC) Reimbursement

In general, the ASC payment rate for services is set at approximately 65% of the payment rate for the same service under the HOPPS, with some exceptions.3 For example, for device-intensive services (where device costs account for more than 50 percent of the total cost of the service), ASCs receive the same payment rate for the device cost as under the HOPPS, with payment for the service portion of the ASC rate calculated at the usual percentage rate of the corresponding OPPS service payment. ASCs will not typically bill separately for these devices.4

CMS has assigned APC-based payment rates in an Ambulatory Surgery Center only to surgical procedure codes – CPT® codes in the range 10000 – 69999, plus a few Category III codes, C-codes, and G-codes. Radiology procedures, supplies, and devices

3 Medicare and Medicaid Programs: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs Questions and Answers. https://www.cms.gov/medicare/medicare-fee-for-service-payment/ascpayment/downloads/asc_qas_03072008.pdf 4 Revised Payment System Policies for Services Furnished in ASCs Beginning CY 2008. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ASCPayment/ASC-Regula- tions-and-Notices-Items/CMS1213393.html. 6 of 11 2018 Endovascular Reimbursement Coding Fact Sheet

are considered ancillary to the surgical procedure; while some are reimbursed additionally, no separate payment is made for cholangiography imaging procedures.

Ambulatory Surgery Center Reimbursement for Endovascular Procedures CPT® 2018 Medicare Base Description Code Payment Rate5 Lower Extremity Interventions 37220 Angioplasty, iliac artery, unilateral, initial vessel $4,846 37221 Stent placement(s), iliac artery, unilateral, initial vessel; $8,600 37224 Angioplasty, femoral, popliteal artery(s), unilateral $4,846 37225 Atherectomy, femoral, popliteal artery(s), unilateral $8,600 37226 Stent placement(s), femoral, popliteal artery(s), unilateral $8,600 37227 Stent placement(s) and atherectomy, femoral, popliteal artery(s), unilateral $13,292 37228 Angioplasty, tibial, peroneal artery, unilateral, initial vessel $4,187 37229 Atherectomy, tibial, peroneal artery, unilateral, initial vessel $13,292 37230 Stent placement(s), tibial, peroneal artery, unilateral, initial vessel $13,292 0238T Transluminal atherectomy; iliac artery, each vessel $7,589 Angioplasty / Stenting in Other Vessels 37236 Transcatheter placement of an intravascular stent(s), open or percutaneous, with $3,923 radiological S&I and angioplasty; initial artery 37238 Transcatheter placement of an intravascular stent(s), open or percutaneous, with $4,250 radiological S&I and angioplasty; initial vein 37246 Transluminal balloon angioplasty, open / percutaneous, with radiological S&I; initial artery $2,182 37248 Transluminal balloon angioplasty, open / percutaneous, with radiological S&I; initial vein $2,182 Dialysis Circuit Imaging and Intervention 36901 Introduction of needle(s) and/or catheter(s), dialysis circuit, with diagnostic angiography of $612 the dialysis circuit, including inferior or superior vena cava 36902 With transluminal balloon angioplasty, peripheral dialysis segment $4,846 36903 With transcatheter placement of intravascular stent(s), peripheral dialysis segment $8,600 36904 Percutaneous transluminal mechanical thrombectomy and/or infusion for thrombolysis, $4,846 dialysis circuit, any method, including S&I, diagnostic angiography, fluoroscopic guidance, catheter placement(s), and intraprocedural pharmacological thrombolytic injection(s); 36905 With balloon angioplasty $8,600 36906 With intravascular stent(s) $13,293 Thrombolysis / Mechanical Thrombectomy 37211 Transcatheter therapy, arterial infusion for thrombolysis, initial treatment day $4,264.67 37212 Transcatheter therapy, venous infusion for thrombolysis, initial treatment day $2,492.57 37184 Primary percutaneous transluminal mechanical thrombectomy; initial vessel $4,845.97

5 Medicare and Medicaid Programs: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; Addenda AA, BB, and D1; http://www.cms.gov/HospitalOutpatientPPS, published by the Centers for Medicare and Medicaid Services (CMS-1678-FC) in the Final Rule [CMS-1656-FC] on August 14, 2017, and published in the Federal Register on December 14, 2017. 7 of 11 2018 Endovascular Reimbursement Coding Fact Sheet

Ambulatory Surgery Center Reimbursement for Endovascular Procedures CPT® 2018 Medicare Base Description Code Payment Rate5 37187 Percutaneous transluminal mechanical thrombectomy, vein(s) $4,845.97 Percutaneous transluminal mechanical thrombectomy, vein(s), repeat treatment on 37188 $2,492.57 subsequent day during course of thrombolytic therapy Other Supportive Procedures 37197 Transcatheter retrieval, percutaneous, of intravascular foreign body $2,492.57

Notes: Most add-on codes are status “N1”, indicating they are packaged into the primary procedure.

Hospital Outpatient Reimbursement

Outpatient facility claims also report CPT® and HCPCS codes, which map to Ambulatory Payment Classifications (APCs), which assign a Medicare hospital outpatient payment rate for the service. Depending upon the services provided, hospitals may receive payment for more than one APC per patient encounter. If a claim contains services that result in an APC payment but also contains packaged services, no separate payment for the packaged services will be provided, as these are included in the APC. However, charges related to the packaged services are used for outlier and Transitional Corridor Payments (TOPs) as well as for future rate setting. Therefore, it is extremely important that hospitals report all HCPCS codes consistent with their descriptors; CPT® and/or CMS instructions and correct coding principles, and all charges for all services they furnish, whether payment for the services is made separately or is packaged.

Common APCs for Endovascular Procedures7 APC Description Status 2017 2017 Indicator Relative Medicare Weight Base Payment Rate Level 1 Vascular Procedures (codes 36901, 37213, 37214, 76731, 75746, 5181 T 7.7894 $612.53 75820, 75822, 75827, 75870, 75872, 75880, 75898) Level 2 Vascular Procedures (codes 36221, 36222, 36225, 36251, 36252, 36254, 37192, 37193, 37213, 37214, 37188, 37192, 37193, 37197, 37212, 5182 (Q2) T 12.4994 $983 75600, 75625, 75630, 75658, 75710, 75716, 75733, 75741, 75743, 75756, 75825, 75831, 75833, 75840, 75860) Level 3 Vascular Procedures (codes 36223, 36224, 36226, 36253, 37191, 5183 T 31.6976 $2.493 37211, 37184, 37187, 37191, 37211, 75605, 75705, 75726, 75736, 75842) 5191 Level 1 Endovascular Procedures (codes 37220, 37224) J1 37.7543 $2,832 Level 2 Endovascular Procedures (codes 36902, 36904, 37220, 37224, 5192 J1 61.6254 $4,845.97 37236, 37238, 37246, 37248) Level 3 Endovascular Procedures (codes 36903, 36905, 37221, 37225, 5193 J1 129.9758 $9,748 37226, 37228, 37236, 37238, 37241-37244, 0234T, 0236T, 0237T) Level 4 Endovascular Procedures (codes 36906, 37227, 37229, 37230, 5194 J1 169.0312 $13291.94 37231, 0238T) 5571 Level 1 Imaging with Contrast (code 75635) Q2 (S) 3.2138 $252.72

Notes: Diagnostic catheter placement codes are packaged with the related imaging procedure, whereas imaging guidance is packaged with interventional procedures. Carotid

6 Healthcare Common Procedural Coding System (HCPCS) codes are developed by CMS and available in book form from several different publishers. 8 of 11 2018 Endovascular Reimbursement Coding Fact Sheet

artery stenting procedures (37215-37218) are not reimbursed through HOPPS, but are classified as inpatient-only procedures. Most add-on codes are status “N”, indicating they are packaged into the primary procedure.

OPPS payment status indicators (SIs) indicate whether a service represented by a HCPCS or CPT® code is payable under the OPPS or another payment system, and also whether particular OPPS policies apply to the code (eg, multiple procedure discounts or other payment reductions, full separate payment, or is a service packaged with another procedure). Relevant OPPS Status Indicators include:

C Inpatient Procedures; not paid under OPPS. J1 Comprehensive code: all covered Part B services on the claim are packaged with the primary J1 service for the claim, except services with OPPS SI = F, G, H, L and U; ambulance services; diagnostic and screening mammography; all preventive services; and certain Part B inpatient services. N Payment is packaged into payment for other services, including outliers; no separate APC payment. Q2 T-Packaged Codes: (1) packaged APC payment if billed on the same claim as a HCPCS code assigned status indicator “T”; (2) in other circumstances, payment is made through a separate APC payment. S Procedure or service not discounted when multiple; separate APC payment. T Significant procedure, multiple procedure reduction applies; separate APC payment. Modifiers

When submitting a particular service on a claim, it is sometimes necessary to report a modifier with the CPT® code. A modifier allows a way to indicate that a service or procedure that has been performed has been altered by some specific circumstance but not changed in its definition or code. Modifiers also enable health care professionals to effectively respond to payment policy requirements established by other entities. Some modifiers apply to either physician or hospital outpatient claims; some may only be relevant for one or the other. A complete list of modifiers is included in the HCPCS and CPT® coding books; the concept of modifiers does not apply to ICD-10-PCS procedure codes. Hospital Inpatient Reimbursement Selecting the Appropriate ICD-10-PCS Code

ICD-10-PCS, including the ICD-10-PCS Official Guidelines for Coding and Reporting, replaced ICD-9-CM procedure codes for dates of discharge for inpatients that occur on or after October 1, 2015. ICD-10-PCS is not related to ICD-10-CM, but was developed specifically to meet healthcare needs for a procedure code system.

The following table lists some of the most commonly used code categories for endovascular diagnostic and therapeutic procedures. Given the large number of individual procedure codes available for procedures in ICD-10-PCS, please refer to your coding reference book or coding software to look up the associated Body Part, Approach, Contrast, Device and/or Qualifier that best align to the procedure performed as identified below.

Comon ICD-10-PCS Endovascular Procedure Code Categories7

Procedure Description Procedure Description Angiography and Other Imaging Percutaneous Atherectomy or Thrombectomy B21– – – – Imaging of heart, fluoroscopy 03C–3Z – Percutaneous extirpation of upper arteries B31– – – – Imaging of upper arteries, fluoroscopy 04C–3Z – Percutaneous extirpation of lower arteries B41– – – – Imaging of lower arteries, fluoroscopy 05C–3ZZ Percutaneous extirpation of upper veins B51– – – – Imaging of veins, fluoroscopy 06C–3ZZ Percutaneous extirpation of lower veins B34–ZZ3 Intravascular imaging of upper arteries Occlusion / Embolization

7 Medicare and Medicaid Programs: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; Addendum D1; http://www.cms.gov/HospitalOutpatientPPS, [CMS-1677-F]. 9 of 11 2018 Endovascular Reimbursement Coding Fact Sheet

Comon ICD-10-PCS Endovascular Procedure Code Categories7

Procedure Description Procedure Description B44–ZZ3 Intravascular imaging of lower arteries 03L– – – Z Occlusion, upper arteries B54–ZZ3 Intravascular imaging of upper veins 04L– – – Z Occlusion, lower arteries B64–ZZ3 Intravascular imaging of lower veins 05L– – – Z Occlusion, upper veins B32– – – – Computed tomography, upper arteries 06L– – – Z Occlusion, lower veins B42– – – – Computed tomography, lower arteries Insertion of Other Devices B52– – – – Computed tomography, upper veins 03H– – – Z Insertion, upper arteries B62– – – – Computed tomography, lower veins 04H– – – Z Insertion, lower arteries Percutaneous Angioplasty / Stent Placement 05H– – – Z Insertion, upper veins 037–3 – – Percutaneous dilation of upper arteries 06H– – – Z Insertion, lower veins 047–3 – – Percutaneous dilation of lower arteries Measurement and Monitoring 057–3 – – Percutaneous dilation of upper veins 4A033– – Measurement, arterial, percutaneous 067–3 – – Percutaneous dilation of lower veins 4A043– – Measurement, venous, percutaneous Other Supportive Therapies 03WY– – Z Revision (of device), upper artery 03PY– – Z Removal (of device), upper artery 04WY– – Z Revision (of device), lower artery 04PY– – Z Removal (of device), lower artery 05WY– – Z Revision (of device), upper vein 05PY– – Z Removal (of device), upper vein 06WY– – Z Revision (of device), lower vein 06PY– – Z Removal (of device), lower vein 3E0– – – – Injection or infusion

If different methodologies are used in different sites of a single vessel (eg, angioplasty only, angioplasty with stenting, or atherectomy), the same root operation is performed on multiple body parts (eg, peripheral vessels), or if multiple root operations with different objectives are performed on the same body part, code each separately.8 MS-DRGs

Medicare reimburses inpatient hospital services under the Inpatient Prospective Payment System (IPPS), which bases payment on Medicare Severity Diagnosis-Related Groups (MS-DRGs). The MS-DRG payment system groups similar diagnoses into a single payment level, and reimburses the hospital according to the extent of resources typically required to treat patients with similar diagnoses undergoing similar treatments.

All services and supplies provided during the inpatient admission are bundled into a single MS-DRG reimbursement rate, regardless of the length of the inpatient stay, the intensity of treatments, or the number of procedures performed for the specific individual.

Common MS-DRGs for Endovascular Procedures9 2018 Medicare MS- 2018 Mean 2018 Relative Description Base Payment DRG Length of Stay Weight Rate10 034 Carotid artery stent procedure with MCC 7.6 3.9913 $24,060 035 Carotid artery stent procedure with CC 3.1 2.2276 $13,428 036 Carotid artery stent procedure without CC/MCC 1.5 1.7636 $10,631 166 Other respiratory system O.R. procedures with MCC 10.4 3.547 $21,382 167 Other respiratory system O.R. procedures with CC 5.7 1.8497 $11,150

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Common MS-DRGs for Endovascular Procedures9 2018 Medicare MS- 2018 Mean 2018 Relative Description Base Payment DRG Length of Stay Weight Rate10 Other respiratory system O.R. procedures without 168 3.1 1.2904 $7,779 CC/MCC 252 Other vascular procedures with MCC 7.6 3.2334 $19,491 253 Other vascular procedures with CC 5.5 2.535 $15,281 254 Other vascular procedures without CC/MCC 2.9 1.8127 $10,927 270 Other major cardiovascular procedures with MCC 9.5 4.9411 $29,785 271 Other major cardiovascular procedures with CC 5.8 3.3836 $20,397 Other major cardiovascular procedures without CC/ 272 2.8 2.4538 $14,792 MCC 299 Peripheral vascular disorders with MCC 5.3 1.4112 $8,507 300 Peripheral vascular disorders with CC 4.2 1.0184 $6,139 301 Peripheral vascular disorders without CC/MCC 3 0.7251 $4,371 673 Other kidney and urinary tract procedures with MCC 10.7 3.5242 $21,244 674 Other kidney and urinary tract procedures with CC 7 2.3165 $13,964 Other kidney and urinary tract procedures without 675 3.3 1.6406 $9,890 CC/MCC

MCC = major complication or comorbidity CC = complication or comorbidity

8 CMS Fact Sheet: ICD-10-CM/PCS, The Next Generation of Coding, https://www.cms.gov/Medicare/Coding/ICD10/downloads/ICD-10Overview.pdf and 2016 ICD-10-PCS Reference Manual, https://www.cms.gov/Medicare/Coding/ICD10/2016-ICD-10-PCS-and-GEMs.html 9 Centers for Medicare and Medicaid Services, FY17 Final Notice Data, Table 5 - List of Medicare Severity Diagnosis-Related Groups (MS-DRGs), Relative Weighting Factors, and Geo- metric and Arithmetic Mean Length of Stay; http://www.cms.gov/AcuteInpatientPPS/ (under Acute Inpatient – Files for Download) 10 The MS-DRG payment amounts indicated are estimates only based upon data elements derived from various CMS sources. MS-DRG national average payments were calculated with a base rate of $6208.08 using the national adjusted operating standardized amounts and the capital standard federal payment rate as issued in the Medicare Inpatient Prospec- tive Payment System Final Rule published in the Federal Register (Vol. 82, Issue 239) on 12/14/17; Tables 1A and 1D,Table 5, and assume that all hospitals are receiving the full 1.65% quality reporting and meaningful use updates. Actual payment may vary based on various hospital-specific factors not reflected in the source data.

The information in this guide is broad-based and references many different procedures and types of devices. Such a broad discussion is not intended to suggest or imply that Cordis® offers products for every use or procedure discussed and the FDA-cleared or approved labeling for all products may not be consistent with the information in this guide. Important information: Prior to use, refer to the instruction for use supplied with this device for indications, contraindications, side effects, suggested procedure, warnings and precautions. Caution: Federal (USA) law restricts this device to sale by or on the order of a physician. © 2018 Cardinal Health. All Rights Reserved. CORDIS and the Cordis LOGO are trademarks of Cardinal Health and may be registered in the US and/or in other countries. All other marks are the property of their respective owners.

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